Fluid and Electrolyte Imbalance in Nursing Education

FLUID AND ELECTROLYTE IMBALANCE PRESENTED BY- MISS ADITI JANE LECTURER IIMT UNIVERSITY COLLEGE OF NURSING

Body fluids are distributed in two distinct area- Intracellular flui9d (ICF) 40% body weight Extracellular fluid (ECF) 20% body weight Interstitial fluid- 15% body weight Plasma- 5% body weight

ELECTROLYTE IN BODY FLUIDS

MECHENISM CONTROLLING FLUID AND ELECTROLYTE MOVEMENT Diffusion Facilitated diffusion Active transport Osmosis Hydrostatic pressure

OSMOSIS- fluids shift through the membrane from the region of low solute concentration to the region of high solute concentration until the solution are of equal concentration. DIFFUSION- a substance to move from an area of higher concentration to one of the lower concentration.

FLUID IMBALANCE FLUID IMBALANCE

ABNORMALITIES IN THE REGULATION OF BODY FLUID Fluid volume deficit n(ECFVD)- dehydration Fluid volume excess- over hydration

EXTRA CELLULAR FLUID VOLUME DEFICIT (ECFVD) A decrease in intravascular and interstitial fluids. It is a common and serious fluid balance that results in vascular fluid volume loss (hypovolemia)

RISK FACTORS Diarrhoea Vomiting Diabetic ketoacidosis Haemorrhage Difficulty in swallowing Severe mentally ill patient

DEGREE OF DEHYDRATION Mild Moderate severe

MILD DEHYDRATION Thirst Reduce appetite Skin flushing Dark coloured urine Dry mouth Fatigue Mild headache Chills dizziness

MODERATE DEHYDRATION Decreased sweating and urination, increase heart rate, respiration and body temperature. Extreme fatigue Muscle cramps Severe headache Nausea Constipation Tingling numbness

SEVERE DEHYDRATION Muscle cramps Vomiting Rapid pulse Temporary blindness Painful urination Confusion Respiratory depression Neuromuscular seizures Chest pain unconsciousness

DIAGNOSTIC EVALUATION Increased osmolarity Increased or normal serum sodium level BUN (more than 25mg/dl) Increased specific gravity or urine

MANAGEMENT Oral rehydration IV fluids Dietary management Nursing management

NURSING MANAGEMENT Measure all fluids that enter and leave the body. Check electrolytes, CBC, and urine specific gravity. Assess for hypotension and weak pulse. Assess respiratory system and tissue perfusion. Check orientation, vision, hearing , reflexes and muscle strength. Check for weight changes Check for skin break down and good oral care

EXTRA CELLULAR FLUID VOLUME EXCESS/ OVER HYDRATION ECFVE increased fluid retention in the intravascular and interstitial spaces

ETIOLOGY Administering fluids rapidly or in large amount Failure to excrete fluids Heart failure Renal disorder Decreased plasma proteins Venous obstruction

SIGN/SYMPTOMS NEUROGENIC Confusion Headache Seizures RESPIRATORY Pulmonary congestion

SIGN/SYMPTOMS CARDIOVASCULAR Increased BP Tachycardia Bounding pulse GASTROINTESTINAL Anorexia nausea

DIAGNOSTIC EVALUATION Decreased osmolarity Decreased or normal serum sodium level BUN (more than 8mg/dl) Decreased specific gravity or urine Decreased hematocrit(less than 45%)

MANAGEMENT ECFVE is treated by the addition of solutes to IV fluids. Use of D5%, 0.45% Nacl will help to correct ECFVE. WHEN THE CAUSE IS WATER EXCESS Oral fluids such as water and soft drinks should be given in addition to water. IV therapy should be monitored every hour. Monitor vitals and IO Weight should be checked daily to measure fluid gain or loss

ACID/ BASE The body normally maintains a steady balance between acid produced during metabolism and bases that neutralize and promotes the excretion of the acid, many health problems lead to acid base imbalance. Patient with DM, COPD, kidney disease frequently develop acid-base imbalance.

ACID BASE REGULATION The body metabolic processes constantly produce acids. These acid must be neutralized and excreted to maintain acid base balance. Normally the body has three mechanism by which it regulates acid-base balance to maintain the arterial ph- 7.35 and 7.45. Buffer system respiratory system Renal system

BUFFER- reacts immediately RESPIRATORY- respond minutes and reaches maximum effectiveness in hours RENAL- takes 2-3 days to respond maximally

CLASSIFICATION Respiratory imbalance It affects carbonic acid concentration Metabolic imbalance It affects the base bicarbonate

RESPIRATORY ACIDOSIS It is a clinical disorder in which the PH is less than 7.35. PaCo2 (partial pressure of Co2) is greater than 42mmhg. It may be either acute or chronic. CAUSES Elevated plasma level Elevated carbonic acid Acute pulmonary oedema Impaired respiratory muscles

CLINICAL MANIFESTATION Increased pulse Increased respiratory rate Increased BP Cerebrovascular vasodilation Increased intra cranial pressure Feeling of fullness in head

MEDICAL MANAGEMENT PHARMACOLOGIC AGENT Broncho dilators Antibiotics Anti-coagulant PULMONARY HYGIENE MEASURE Adequate hydration Mechanical ventilation

RESPIRATORY ALKALOSIS It is a clinical condition in which the arterial PH is more than 7.45 and paCo2 is less than 38mmHg. CAUSES Hyperventilation Anxiety Hypoxemia Decreased serum bicarbonate level Cerebral tumors

CLINICAL MANIFESTATION Light headiness due to vasoconstriction Decreased cerebral flow Numbness Loss of consciousness Tachycardia

MEDICAL MANAGEMENT Treatment depends on the underlying cause respiratory alkalosis. Patient is instructed to breath more slowly to allow Co2. Sedatives may be required to relieve hyperventilation in very anxious patient

METABOLIC ACIDOSIS Clinical disturbance characterized by low PH and low plasma bicarbonate concentration Produced by gain of hydrogen ion or loss of bicarbonate

CLINICAL MANIFESTATION Headache Confusion Drowsiness Increased respiration Nausea Vomiting Decreased BP Cold and clammy skin shock

MEDICAL MANAGEMENT Treatment is directed at correcting the metabolic defect. Bicarbonate is administered if the PH is less than 7.1. Serum potassium level is monitored closely.

METABOLIC ALKALOSIS Clinical disturbance characterised by high PH and high plasma bicarbonate concentration. It can be produced by a gain of bicarbonate or a loss of H+ ions. CAUSES Vomiting Gastric suction Cystic fibroid Chronic ingestion of milk

CLINICAL MANIFESTATION Tingling Dizziness Ventricular disturbance (PH increase above 7.6)

MEDICAL MANAGEMENT Sufficient chloride must be supplied for kidney to absorb sodium with chloride Administer sodium chloride fluids Input and output should be monitored.